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What to expect from the M ichel Temer government in the health carearea
Rev Assoc Med B ras 2016; 62(8):709-710 709
EDITORIAL
What to expect from the Michel Temer government in the
health care area
O que se espera do governo Michel Temer na área da saúde
Elias Jirjoss Ilias1
1PhD Professor, Department of Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo, SP, Brazil
After the Dilma Rousseff government, the question asked
by health care and medical education professionals is:
what will the Michel Temer government do to improve
the area? Some measures are urgent given the chaos in
Brazilian health, especially after the interventionist blun-
ders of the previous government, which was characterized
primarily by demagogic and dictatorial attitudes, both in
medical education and in assistance to those in need.
SUS, the Unified Health System
Given the economic recession, managing one of the world’s
largest health systems in the world, which today serves 75%
of the country’s population directly, will be a majorly com-
plex challenge for the Michel Temer government. Current
Minister of Health Ricardo Barros has already said that, in
the medium term, the country can no longer afford rights
guaranteed by the Constitution, such as universal access
to health. The federal government has to invest at least
13.2% of its net revenues in health. But what is the trick to
secure more money for SUS?
One of the solutions that could be put on the table
would be a surcharge of products harmful to health, such
as soft drinks and cigarettes, or to eliminate a number of
notorious tax exemptions. A study by the Institute of Applied
Economic Research (IPEA, in the Portuguese acronym) point-
ed out that on account of the deduction of health-related
expenses in the income tax of individuals and companies,
the government fails to collect BRL 16 billion per year.
A proposal presented by the new government to relieve
SUS would be to create low-cost health insurance for the
poorest sections of the population. Although these plans
already exist in other countries, we must wait for more
details on its scope before issuing a more accurate opin-
ion. But even in view of the unquestionable underfunding
of the sector, health economists argue that it is possible
to better spend the current funds, improving the man-
agement of services, curbing waste and fraud, and giving
priority to prevention and health promotion.
Today, the legalization of health also costs about BRL
7 billion in federal, state, and municipal funds. The actions
use the universal law proposed in the Constitution to get
drugs and other treatments. The way out is to create pro-
tocols for recognized therapies made with the help of
serious medical entities committed with good medical
practice so that the judiciary could be better informed
before issuing an injunction for treatment provision with-
out the slightest scientific basis.
Supplementary insurance
Due to the economic crisis and unemployment, it is es-
timated that nearly 2 million people will end 2016 with
no health insurance, which means they will have to knock
on the door of the already underfunded and scrapped
SUS. The country spends little on health, less than the
world average, and most of the expenditure comes from
the private sector. Out of the total invested of 8.5% of
the Gross Domestic Product (GDP), 4.9% derive from the
private sector, while only 3.6% come from public funds.
The amount paid by consumers for health plans had
incredible increases in recent years, mainly due to the
incorporation of new technologies and treatments. Today,
it is almost impossible to hire an individual health plan.
Operators prefer corporate and group plans because they
are not subject to restrictions in the increase of month-
ly fees, as is the case with individual plans. The increase
in the value of health plans far above the inflation makes
this a very expensive option for many families, causing
more queues for SUS care. In this catastrophic scenario,
creating popular health plans seems a viable and realis-
tic option. Nevertheless, this requires discussion, espe-
cially involving the consumer.
Medical education
In a recent article, professor Antonio Carlos Lopes ad-
dressed this problem very well. Between 1500 and 1999,
Brazil created 106 medical schools, most of which with
the necessary structure for proper training. The thing is
that entrepreneurs of education realized the high demand
for openings in medical courses is a gold mine associated
with prestige and wealth. Result: in the last 14 years, over